Orthopaedic Pain
Mark V. Boswell, B. Eliot Cole in Weiner's Pain Management, 2005
Kyphoplasty and vertebroplasty are two relatively new procedures aimed at the treatment of painful vertebral compression fractures. Currently, both techniques involve the injection of bone cement into the vertebral body to provide additional strength. While kyphoplasty has as a part of the procedure the restoration of normal anatomy in deformed bodies, its goal is restoration of strength lost as a result of osteoporosis and fracture. Vertebroplasty has as a goal only the restoration of strength. The use of bone cement may in the future be supplanted by “bone filler.” There are currently several under investigation. The increasing age of the population indicates that procedures such as these will be more frequent in the future. As a technique for pain relief, they are minimally invasive and can be performed on an outpatient basis using general or even conscious sedation anesthesia. Pain relief is also nearly immediate. If other levels are affected at a later date, the procedure can be repeated at those levels.
Augmentation of fracture fixation
Peter V. Giannoudis, Thomas A. Einhorn in Surgical and Medical Treatment of Osteoporosis, 2020
Elsner et al. studied 18 patients with intra-articular calcaneal fractures treated with open reduction and internal fixation and augmentation with an injectable carbonated apatite cement. Functional follow-up studies using the Zwipp Foot Score and densitometry were performed at 6-month intervals postoperatively. Histological samples of biopsies obtained at the time of hardware removal (6 months postoperatively) were also analyzed. The use of bone cement led to intermediate-term functional outcomes that were no better than those reported with conventional surgical procedures using bone graft. Patients demonstrated postoperative difficulties similar to those seen in other studies of this fracture, including pain, subtalar motion restrictions, peroneal impingement, and difficulties on uneven terrain and with toe- and heel-walking. However, compared to patients treated surgically without injectable carbonated apatite cement, full weight-bearing on the affected extremity was regained at an average of 4 weeks postoperatively. In addition, autogenous bone graft was not required to fill the osseous defect using this technique, minimizing morbidity and discomfort (26).
The Risks of Silver Nanoparticles to the Human Body
Huiliang Cao in Silver Nanoparticles for Antibacterial Devices, 2017
Orthopaedics is another field where infections are dangerous and their treatment is very difficult and expensive. Nanosilver has been used to cover both orthopaedic implants and materials used for bone regeneration. An interesting example of the latter approach is the use of complexes of bone morphogenic protein-2 (BMP-2) and nanosilver sized 20–40 nm placed in poly(lactic-co-glycolic) acid. They showed strong antibacterial properties and did not present cytotoxic properties that could inhibit an osteoinductive action of BMP-2. The use of bone cement in orthopaedic procedures presents another risk of infections. Experimental studies with bone cement enriched in nanosilver have provided promising results (Alt et al. 2004). Dental seals and dental dressings can also be enriched with nanosilver.
Cementing does not increase the immediate postoperative risk of death after total hip arthroplasty or hemiarthroplasty: a hospital-based study of 10,677 patients
Published in Acta Orthopaedica, 2019
Elina Ekman, Inari Laaksonen, Kari Isotalo, Antti Liukas, Tero Vahlberg, Keijo Mäkelä
Cementing is the gold standard for implant fixation, especially in elderly patients treated for femoral neck fractures. Bone cement has been thought to strengthen bone from inside and, therefore, to decrease the risk for periprosthetic fracture, osteolysis, and loosening. All major registries show lower revision rates for cemented implants in elderly patients with OA (Swedish Hip Arthroplasty Register 2013, AOANJRR 2016, NJR 2016, FAR 2017). Additionally, there is evidence that cementing the stem reduces postoperative pain and leads to better mobility (Parker et al. 2010). Cementing may also decrease the risk of reoperation when compared with uncemented hemiarthroplasty in hip fracture patients (Gjertsen et al. 2012, Yli-Kyyny et al. 2014). Due to these data, the proportion of cemented stems has been increasing recently and 62% of the HA patients in this study were cemented. Earlier studies reported that cementing of the hip device was associated with a risk of BCIS increasing perioperative morbidity and mortality (Coventry et al. 1974, Ereth et al. 1992, Parvizi et al. 1999). It has been suggested that the risk of BCIS might be increased in hip fracture patients who are, in general, old and fragile and have several comorbidities (Keating et al. 2006, Moja et al. 2012). Improvements in surgical and anesthesiology techniques and implants, the use of low molecular weight heparins (LMWHs) in the 1980s, and operating room sterility have significantly reduced overall mortality risks associated with hip arthroplasty.
Early postoperative mortality similar between cemented and uncemented hip arthroplasty: a register study based on Finnish national data
Published in Acta Orthopaedica, 2019
Elina Ekman, Antton Palomäki, Inari Laaksonen, Mikko Peltola, Unto Häkkinen, Keijo Mäkelä
Cementing is the gold standard for implant fixation, especially in elderly patients. In combined Nordic data, risk for revision has been both statistically and clinically significantly lower with cemented implants than with uncemented implants in patients aged 65 years or more (Mäkelä et al. 2014a, Varnum et al. 2015). Bone cement has been thought to strengthen bone from inside and therefore to decrease the risk for periprosthetic fracture, osteolysis, and loosening. Lower revision rates for cemented implants in elderly patients have been found in all major registries (Swedish Hip Arthroplasty Register 2013, AOANJRR 2016, NJR 2016). Even though superiority in implant survival of cemented THA in elderly patients, fear of bone cement implantation syndrome (BCIS) has led many surgeons towards using uncemented implant fixation (Dale et al. 2009, Fevang et al. 2010, Mäkelä et al. 2014b). BCIS is characterized by perioperative hypotension and hypoxia, and at worst cardiac arrest and death of the patient. The true incidence of cardiac arrest secondary to BCIS is unknown (Donaldson et al. 2009). In our study the 1- and 2-day adjusted mortality was similar in the cemented and uncemented THA groups. Thus, BCIS is seldom a cause of death in elective THA patients in Finland.
Treating patients with renal cell carcinoma and bone metastases
Published in Expert Review of Anticancer Therapy, 2018
Annalisa Guida, Bernard Escudier, Laurence Albiges
When surgery is not suitable, radiotherapy or cimentoplasty may represent an option in selected case. Cementoplasty consists of injection of bone cement into bone lesions and it is used alone or in combination with other techniques. In several retrospective series, including few RCC patients (totally less than 10), combined cementoplasty with ablation have shown efficacy in control pain and recovery in daily activities [61,62]. One other combination approach is embolization radiofrequency and cementoplasty for local control of painful BMs. Pellerin et al. reported prospective data on 52 consecutive patients with mRCC. Median VAS score decreases from 7 to 3 (p = 0.001); there was a significant difference in narcotic use with a marked improvement in quality of life parameters [63].
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